That was the last thought...

Peace!

Trust...

Every time I go to work, people initially trust me!  That's an awesome feeling!  You see, I'm a nurse and I work in the ED...

I always initially trust the patients that come into my care, will advocate for them, try to address there immediate needs...

However, occasionally that trust is broken.  When you are "allergic" to every medicine/drug except the one specific one you want... my eyebrow will be raised.  And when you tell me that there is only one specific medicine/drug that will work for you... and this your 4th visit in a week...both my eyebrows will be raised.  But I will still attempt to start your IV, cutting off the other hospitals ID band to access a vein, so you can get your medicine/drug...  I will even use the US (ultrasound) to identify that small vein in your arm to be able to give you that relief that you need!

But when I get a critical patient, that is literally trying to die...

And I get a little busy...

When you activate the call light, please, please don't have an attitude... with me or the person that responds to your request... especially when it is for food (we are not a cafeteria), a pillow or blanket (we are not a hotel), or more pain medicine (when you just got a dose 5 minutes ago and you have 15 more minutes till you can have another) when you know the time-frame for more!

Some of the best times I have ever experienced in the ED is when a critical patient has the attention of not only most the staff... but most of the other patients in the ED!  Seems when the other patients realize that a person is on the verge of dying, and every person in the ED is trying to save there life... often most of the patients are gaping... that's when the requests become almost non-existent!

So, please trust me again...  if it seams that you are being ignored, you're probably stable, not going to die of starvation, hard stretcher, or chilliness of the room!

But a few will still complain...  oh well... one million complaints will not even to begin to affect the feeling of just one saved life... or the gratitude's/compliments of those families!


Peace!

Life...

There comes a point in everyone's life that they take a pause, look back, look forward, and make a choice.

That time came to me today.

Hard to take the news, but in retrospect it is not worse than things I have already experienced.  So as I look back, I have to laugh!  I thought those things were bad and that I would never live through them, but I did!  So here I am.

And as bad as you think I am, as bad as I have been, and as bad as I really am... I am still here.  Too bad!  Eh!?

Life continues, it goes on.

As someone that once contemplated, I will once again laugh!  I laugh at the company that made a decision that cost them hundreds of dollars a month, I laugh at the people that have no idea what there decision has set into being!  I have made decisions myself, and the events that those decisions have caused, I am truly amazed!

So this is my last post for some time, because I need to become silent.  If you know me, and need to talk to me, you already know how to reach me...

Good night.

Just in case someone still reads this...

If you are ever arrested and brought to jail... do not become so uncooperative and combative that you get "tazed!"

It can lead to a cardiac arrest...

A few days in the ICU will tell if any type of recovery is possible.  But between the First Responders, EMS, and the ED... this patient survived to get to the ICU!

Who cares...

No one reads this.  Time to stop.

And then God laughs when you tell Him your plans...

I rode down a street, which turned into a road.  This road then turned into a Highway...

There was a mountain in front of me for the first part, it somehow drifted off to my left, no longer an obstacle, as I continued down the road.

And as hard as I searched, random turns to the left, then right...after almost an hour, I finally saw it.

I found the end of a road.  A dead end.  Luckily there was a sign that warned me, so I turned away from it and strarted home.  But I found it!

I know where it is...

A Ride!

To be completely honest, the idea generated in 2003.

It resurfaced a year ago,but this year, has now become a mission!

I will keep posting, as I begin the preparations, yes it takes a lot of planning!

Really! Is there some hope?

I cared for my very first patient that was allergic to morphine and dilaudid!!!

Expecting something else perhaps?  Who knows... but to say that they have an allergy to these two drugs... wow!

I need a change...

Seems I have become cynical in my grand age..

A curse, passed on by elders.  They saw it, they recognized it, they got it.

I admit, I am a little late in recognizing it...

I just admitted to myself...

I am a drug pusher!

I went to Haiti, just a month after the devastating earthquake.  I wish there was dilaudid there, nothing but morphine and fentanyl.  And every morning I opened up the "ED,"  I was missing all of the ibuprofen and baby diapers!  But a patient population that was not exposed to narcotics... a 2 mg dose of morphine was more than enough!

But now, here in the US, when a patient comes in with a chief complaint of pain... wherever... and they are allergic to Toradol, Ibuprofen, Compazine, Phenergan, Vicoden, Ultram, Fioricet, Acetaminophen, and Morphine... I raise my eyebrow.  Seems Zofran is still a good drug!

No one is ever allergic to Percocet or dilaudid... seems "allergies" are related to what one does not want...

Whatever!

Waste my time, waste resources, get your fix...

There used to be a time when people came to the ED when they were dead or dying...

If you are dying, we'll save your life... if we have a bed available...

An understanding...

Winter, has arrived early!

I am an ED Nurse, and holding admitted patients in the ED awaiting an inpatient bed, has somehow become the "norm."  It is truly mind boggling that overall, hospital administrators, directors, managers, etc., have not realized that the main entry point for patients admitted to the hospital is the ED.

So when the entire admission process comes to a screeching halt, due to un-staffed beds (that is a bed is available, but no nurses are available to care for the patient)... I wonder about the reimbursement issues.  Now, recently, I can attest that the 31 patients being held in my ED, were a result of a lack of physical beds.  That is the hospital was full!  All available beds were staffed, and occupied.  But there were a few units closed due to renovations, etc.

With all the "metrics" and "QA/QI/CQI/etc."  No one has identified the problem?  No one has hypothesized a solution?  No research has been done?  No application of results have been implemented?

Oh!  I apologize.

The solution increases expenses in a time of decreasing revenues.  Got it!

Wow!

Over 7 years ago...

I was sleeping, alone in the house, early morning (aka after midnight).  I was suddenly awakened by a loud noise, so loud that I jumped out of the bed...  in those brief moments of semi-consciousness, when your body/brain tells you something is very wrong, get up and be prepared to survive...

I heard the car-alarm going off...

I grabbed the phone, and another thing, and went to investigate...

As I exited my front door, I saw my truck smashed, actually still smoking/dusty, and another vehicle, barely "limping" down the street.

I called 911.

I put the other thing away inside, and went back outside.  I quickly determined that my truck, parked in my driveway, had been struck by another vehicle, and said vehicle was now "limping" down the street... as the 911 Operator came on, I explained what had happened, what I was seeing, and what I subsequently was witnessing.

At least two people got out of the car and ran away.  The Police showed up very quickly and was able to detain the driver.  Who was subsequently charged with and convicted of a DUI.  They never got the other two.

When the sun came up, I was able to see the skid marks, the path the offending vehicle took...  I saw that had I actually pulled my truck into the garage, there would have been a vehicle in my kitchen!  Likewise, the glancing blow, caused the vehicle to literally rip through my front yard, completely missing an Ocotillo that was at least 100 years old... based on size and DBG (Desert Botanical Garden) consultation.


To this day, I'm glad the damage was minimal.  I am happy no one was seriously hurt. 

As a few after-notes...

Two weeks later, there was a microburst that toppled that Ocotillo!  A 100 year old plant, missed one death, but was taken anyways!

A few days after the microburst... there was someone who came to my door, asking permission to take some of the "green stalks" in order to try to replant them and allow them to continue to grow!

Now, over 7 years later, I recently saw several Ocotillos growing in an urban wash near that location...  I wonder... and I hope... that at least one of them came from my yard!

My glimpse...

Unfortunately, I have come to the realization that the solution, is so complex, that it is practically unattainable.

It has taken many years, 200+ actually, to get to this point.  Anyone that thinks it will be solved tomorrow, is a fool!  I guess a lot of people have been fooled...

This idea/thread is not finished.  I will post more of my thoughts.  It may be interspersed though...


Peace!

A glimpse...

I barely realized that I had caught a glimpse...

It was almost three hours later, when I was thinking about it again, that I realized that I had almost had it!

So, times are tough.  There are a lot of unemployed people, the actual numbers... who knows!?  The way things are reported are so convoluted!  First time applicants vs. long term vs. under-employed vs. those not looking anymore...  I guess the bottom line is that if you need a job/income and have a job/income, be thankful!  It may not be exactly what you desire, but at least it's something!

A few years ago, I remember saying that "If I lost my job tomorrow, I would be willing to take a minimum-wage job doing whatever..." just to remain employed and have a minimal sustenance.  But a full-time minimum-wage job, amounts to an annual income above the poverty level, so I would not be eligible for any additional government assistance.

And the "crack," the "slip-through," the most used solution...  develops.

Does it suddenly becomes apparent?

(to be continued...)

For Future Archeologists:

The other night, I watched a program on television that was highlighting a Forensic Anthropology program at a major State University... seems they store the "skeletal remains" left over from the research, under the University's football stadium.

I actually laughed at that little snippet...

I can't imagine what future archeologists will say about our present time when they dig through this layer!

Sorry if this somehow upset the entire 'science'... things are not always as they seem...  College Football is not a death match!

So I received a patient into a "Red" Zone... Seizure... within 5 minutes of this patient's arrival, they had been fully intaked (aka Triage done, ESI assignment), physician was at bedside, initial interventions (IV access, blood drawn, etc)...

I had to take the time to actually place a patient sticker on a form, and circle "yes" or "no" on a screening form... answering several questions...

I did this, only after I determined my patient was stable, and I was waiting for our Pharmacy to send me a medication that we don't have/stock in the Emergency Department.  The actual "Nursing Intervention," that is filling out the form, occurred about 30 minutes after the patient arrived, still within the time limit of this Initiative...  but still!

I am disgusted!  I knew that this patient wasn't Septic.  But who am I?  I am, "just a nurse."


Yet I found that this patient fell into the "inclusion" criteria for Sepsis... yet they were not Septic...

Even the subsequent lab results, confirmed they were a candidate for a "pathway" for 'severe' Sepsis...  yet they were not Septic...

Had the ED Physician not listened to me, nor recognized the same thing, there could have been a very different outcome for my patient!  This patient had a lesion on their brain, identified by CT Scan... a cause for there seizure.  Prolonged seizures causes increased body temperature, increased lactate levels, increased CPK... a bump in WBC's...

The next step would have been an LP... that may have been deleterious if it had been performed...

Give thanks to whoever, but my persistence, maybe even my "foot-dragging," as a Professional Nurse... I can honestly say I saved a life!

Yet contrast that with a patient that is hypoxic, hypotensive, tachycardic, tachypnic, mottled, Capillary Refill >5 seconds...again, I as a Professional Nurse knew that this patient was sick!  Luckily the Sepsis Screening wasn't in effect yet!


An ED Physician taking a Respiratory Pathway...  The instance of a nurse, the change of course... Sepsis, an ICU admission, Vascular & Cardiology consults...

I saved a life that day too!


Oh well...

Increasingly difficult... may be time to retire!

It has become increasingly difficult for me, as a Professional Nurse, working in the Emergency Department, to comply with all of the Federal Rules, regarding Emergency Care.

My employer has placed everyone on notice, that there are now Federally Mandated "time limits" on certain actions we take in the ED. 

Door to Doctor
Door to EKG
Door to CT
Diagnosis to this...
Diagnosis to that...

It creates unrealistic expectations!

How does one triage the situation?  A trauma patient that comes in, are they more important than the person having a stroke, or maybe a heart attack?

Trauma Center... Stroke Center... Chest Pain Center...

Really!?

It may result in the ultimate nursing shortage!

Keep your friends...

So I once again found myself in a bad place.  Things were mounting up, changes happening, deadlines looming... I was, to say the least, feeling some stress.


Unfortunately, as I was trying to cope with things on my own and in my own way, I failed to realize that most important thing...  friends... and I lashed out at one of them.  I am ashamed, embarrassed, and humiliated. 

For an individual that has spent most of his adult working life maintaining and being in control of situations, this time I failed miserably!  My actions and words cut deep... I have more than likely permanently changed the relationship and interaction.  I admit, I was physically ill when I realized what I had done.  My sleep, as uneven as it is, became non-existent for a few days.  

I have since apologized.

Since then, only an acknowledgement that they received it, and the words, "I don't know what to say."

I understand that.  It was more than I expected, for that I am grateful.  I don't know if this relationship will be recovered... if it is, I know I forced a change... and for that, I am deeply saddened.

OK, ok, ok... ok... OK!

So I finally succumbed and got what is called a "smart" phone...

I must profess... it seems to be a bit smarter than me, as it has taken at least two days to figure it out!

So this little 'mini' computer, hiding behind the pretense of being a cellphone...  Really!?  I mean who calls anyone anymore?  Isn't it a text, a FB status update, a 'Check-In', or other "non-social" thing?

The biggest social change that we as humans have experienced... is the non-socialiazation of life!

Do you know your next door neighbor?  How about those across the street?  Know anyone a street over?  Ahh.. a memory of being inducted into the "Kathy Street" family... movie nights, house sitting, dog watching...  Another memory of growing up on "Pecos Lane" and the 'community' pool we had, firewood, oh... and those dust storms...

It seems to me, and this is only my opinion, that living has become very complicated!  I must be getting old.  As I am remembering a time when things were different.  I understand that progress must be made, but is it a steamroller effect?  Should we just let go of everything that is 'updated' and embrace the new?  What about the old?

I know how to tie a few knots... I'll give you some rope... can you tie the same?

BTW... I saw that there is an app for this...  point made!

Place

An interesting word.

It can refer to a location, space, atmosphere, region, a spot... social status, a competition, sequence, niche... a condition, position, accommodation, status, or even employment...

I have been thinking about my "place" recently.

I find that I have been guilty of a sin.  I have coveted.

It is a hard thing, to recognize things that others do... yet remain unrecognized for the things that one does.

This is the path I chose though.  So I willingly and gratefully accept my place.  Mostly, because I do what I do, and I am at peace with it!

Loss...

People lose things every day.

Some of these losses are really insignificant... a receipt, a paper, a few dollars; maybe some directions, or a phone number...  Some are more significant... like keys, an important document, cellphones...  But, some are most significant, and cause us to take pause.

The loss of a family member, a pet, a friend...

Most adults realize that death is inevitable, yet we seem to push it off.  Grandparents should leave us before parents, parents before children, children before grandchildren... but life is unpredictable.  Yet regardless of the order, it is always hard.

I have experienced many deaths in my life.  I have had many losses in my life; family, friends, pets... and even patients I have cared for.  I have witnessed some of them, others I have been informed of.  And in each and every time, I have always paused.  I have taken a moment to reflect, to remember, to pray, and even cry.  It never get's easier. 

As an ED Nurse, I still do this when a patient dies.  I take a break, walk away from it, maybe go for a walk outside, maybe call someone to talk about it and decompress... I need a reset, a reboot so to speak... because it will start all over when I get back. 

A friend recently experienced a loss.  I was very sad, as I had met and knew this individual... I cried.

As I mourn this loss, I reflect on my own situation and know another loss is looming in my own family.  There is no way to adequately prepare...  even with all of the faith you have, it still seems to be a shock when it happens, and painful...

Please know that I am thinking about you and him.  And please know that I cried... I can't comfort you directly, but through my words and this memorial... He will live forever in not only your memories, but those of others!

Please, may Peace be upon you!

Some leathers!

I saw a lot of leather yesterday!

Might need to get me some!

9/11 Patriot Motorcycle Ride to Remember

This morning I took part in an event.  The primary purpose was to honor and remember those that lost their lives 10 years ago.  The sight,sound, and feeling of hundreds of motorcycles starting, riding down the road for over a mile in length, going through the Margaret T. Hance, I-10 tunnel and just feeling the rumble, watching in awe as DPS, Phoenix PD, and Mesa PD are zipping by to block traffic, do a complete traffic stop on the Loop 202 even... just to let us ride by.

This hits home for me.

There were people doing there job, supporting this effort, actually risking their lives to provide the support and 'inconviencing' a few motorists at the same time!  There's another post about karma there... but I had no tailgaters on my way home after the ride today, must have been the RW&B on the back of my bike!

My grandfather served in World War II, no one else from my family has entered the Military.  But I chose a different path, and I rode today for not only my grandfather's legacy, but my fellow Firefighter/EMS brethren who risked their lives, and in some cases lost them... to serve there fellow man and Country in the only way they could!

I read some comments lately regarding "it's been 10 years, stop remembering and look to the future..."  I want to say something to these people, but I don't.  When America was attacked on December 7th, 1941... for months, years, even decades after, "Remember Pearl Harbor!"  "Remember December 7th!"  America lost that reminder a few generations later in the 80's, especially after the fall of the Soviet Union...  but this is a lesson hard learned.  My grandfather even said to me as a young child... "Never forget!"  He was talking about Pearl Harbor at the time...

So to those that want to "move-on" and start looking forward... an old Boy Scout trick I learned once is to stop every once and awhile and look back towards where you came from... helps you keep your bearings!  Helps you stay on course!

I choose to remember...

Going for a ride...

Tomorrow, Sunday, September 11th, I will be participating in a ride to pay tribute to those that lost there lives 10 years ago.

The last time something like this occurred, was on December 7th... but several generations later, there seems to be few who realize the significance of what really happened.  I may be old, but it still saddens me...

I will ride.  I will display the Flag of my Nation! 

Streets...

A few days ago, I was involved in a 'resuscitation'...

That is, the patient presented in a respiratory arrest (they stopped breathing), which quickly deteriorated into cardiac arrest (heart stopped beating).  They were clinically dead.

But thanks to modern medicine, they survived; an intubation, CPR, and pharmacological interventions... a restored heartbeat, "bucking" on the tube, this person will survive!  We saved a life!

But there is more to this story...  this patient is well known to most EDs in PHX...

Talk about fate... this was the second time at our facility alone, that this has happened!  Think about that for a second!  Two cardiac arrests, both times successfully resuscitated... to have someone walk out after a few days in the ICU, and continue their life...

Yet there life is such, that they continue behaviors that put them at risk.

I am sure I will see this patient again... hope there luck follows them!

A 'well' deserved break!

I have been working a lot!  My schedule has been a bit chaotic these past few months, but I just recently finished a 3x1x3!  So... I have a "5-off'r!"

I'll take this break!

Peace!

I hear God laughing!

You see...

I had plans, even was making some new ones.  But once again, I was humbled.

You would think I would know better by now!

Someone asked me...

'Why do you do what you do?'  The question was related to being a nurse, specifically an Emergency Nurse.  It was in regards to a patient that was totally dependent for all care, that I asked the 'questioner' for assistance in providing some ADL's.  It was a messy situation... even the family stepped out of the room!  This person is  considering furthering their education and becoming a nurse...

Think about that question for a minute... "Why do you do what you do?"

Of course every one of us, has an immediate answer; however, there is a deeper reason that most don't think about often and find it difficult to articulate.

I could have done anything I wanted!  Got the education, the degrees, been/done anything!  But I followed a path... and here I am.  It has been the right direction for me, but I may be a little off center, so to speak...  time will tell!

What was your path?

I am comfortable where I am.  What I have done, what I have learned, what I do...  but I find a longing for something more.  Perhaps I will continue my 'formal' education and get the appropriate degree and letters to put after my name.  It won't change what I do much... only that I can 'officially' do what I already do, autonomously...

Then again, I somehow think I am where I need to be... the opportunity to teach and mentor others has been exhilarating!  The sharing of knowledge, experiences, teaching... being a part of another person's professional growth...

So I will ask the question to you...


Why do you do what you do?

The company you keep...

Had a great shift!

Got to meet/see some repeat customers last night!  Had a great crew on, back and forth... the support and help was constantly flowing!  Even had a co-worker profess "their love for me!"  Not really... I just helped them get things done and caught up.  On my part, a triage/check-in, an IV start, blood draw, settling in, initial interventions...  They helped me a few hours earlier do the same.  I had the time and opportunity to pitch in to help them, just as they had done the same for me when I had a critical patient!

This shift was easy for me, as it was my "Friday."  Meaning, last day of work on this rotation... I now have 5 days off!  Woo Hoo!  Nothing would have made it any harder!  My 'theme' of the night was "Bring it on!"

I got off easy... most of my patient's last night were either very ill and straight forward, or not so ill and very easy dispositions. Some of my co-workers however, deserve some "hazard pay!"  But such is life in the ED!  My turn will come around in a few weeks... this I am sure of!

My most momentous accomplishment?  Well there were two...

My first was when I got a patient that presented with an early sepsis... fever, hypotension, decreased LOC... got the 3 "L's" in less than 10 minutes of arrival  (Line, Labs, and specifically... Lactate level)... ABX in less than 30 minutes for a 'raging' Urosepsis... admitted within 2 hours!  More nursing interventions done in the first 30 minutes than physician intervention...

The second... not so glamorous, but the most appreciated by my peers!

A frequent patient....  who was discharged, and was not leaving the ED quickly... kept stopping to talk to other patients, staff members, etc.  This patient ended up directly behind me, and I heard the conversation, directions, and interaction.  So I stood up, turned around...  This patient realized my presence and said, "I'm going...chill 'Bro!'..."  But they did not move... I discreetly took hold of a loop on this patient's "luggage," and truly, gently, directed them towards the exit.  They walked, followed the "guidance" towards the exit, then our Hospital Security took over and made sure they safely exited the building.

I have now been 'voted,' at least for this shift... "most needed to be in the area to deal with 'difficult discharges!'

And through it all... I still love my job!

I am an Emergency Nurse!  I love you to death, but my ultimate goal is to get rid of you!  Discharge or admission... I want you out of here!!!  There are a bunch of sick people here in the ED... you don't need or want to be here longer than you have to!

I have been truly blessed with the ultimate team of co-workers!  We have our shifts... we have our difficulties...

But it truly is amazing how teamwork makes it all work!  I'll keep these friends!  I'll keep this company!


Peace!

Business is business...

You wanna work here?  You gotta pay!  We expect at least 33% of what you earn... if you don't pay... well, we'll come after you!  Take your stuff, maybe even make you go away...

You wanna buy that?  You gotta pay!  We expect about 10% off the top!

This is all for your protection!

You wanna sell that?  You gotta pay!  We expect about 10% off the top of that too, maybe even more if you sell it for a lot!

Hey... Business is business...

I think a RICO Investigation should be launched at once!!!

Unbelievable! Unsustainable!

As a Nurse, if I start an IV and give someone a fluid bolus, like a liter of 0.9% NS... I must now document the "end time" of the fluid bolus!

On the surface, this seems like nothing! But if the IV catheter I used to start said IV, happened to be an 18, 16, perhaps a 14 gauge... the fluid bolus might be completed in 20, 10, maybe 5 minutes.

Why is this important?

Well... it seems that my employer won't be payed for care provided by there employees, like IVF boluses now... unless it takes 31 minutes or greater to complete! So I must either slow my IV drip rate to make a bolus run longer, therefore no longer being a "bolus"... or I have to falsify my documentation, saying it took longer than it did! So I am being encouraged to lie!

Likewise...

An IVF bolus can't take longer than an hour to go in, unless I document a reason! Positional IV, small IV catheter, stopped for a procedure, etc...

And...

If I document an IV initiated, but don't document an end time of the IV, even if it is a Saline Lock...the procedure is not billable!?!?  I started it, the procedure was done, what's the problem?!?!

Please tell me! Who are making these "rules?"

I can tell you that whoever they are, they have absolutely no concept of medicine, nor of the reality of how medicine works!

And did I tell you, these are Medicare Rules?

Guess I should just shut up and let the government continue its take over...

Got It!

Figured it out!

Gonna take a day then press!!!

Five and five...

Five days off... nothing accomplished?  Getting turned around for a five day stretch!

Wonder what I will be presented with/do/come in contact with/have to experience?

Wonder what I impacted these last five days...

Mild... Medium... Hot... and....

Habenero?

I just took a spoonful of a "mild" salsa... said so on the green label!!!!


And someone literally ran away!  This person doesn't do salsa (too spicy)... and Habenero (OMG!)... would probably cause them to drop dead!

I laughed, as I shook that bottle of habenero sauce out on my quesadilla!  Put a single drop on my finger and tasted it... they ran 10 feet to the couch!  A single drop on a plate... luckily, my nephew has just the same palate as I do, and tasted it...  I never saw Jared again...

I think I need to find a "Ghost Chili" or "Scorpion Chili" sauce...  that might be interesting!

Two hours...

When the patient arrived at 9:10pm, the EMS report was basically an altered level of consciousness, fast heart rate, possible dehydration (as the home had no A/C)...

When moving the patient from the ambulance stretcher to the ED bed, it was recognized that the patient was actually having a seizure...

The IV fluids were opened wide, Ativan was administered, monitors applied, and a quick assessment... the patient's core temp was 103+  Immediate ice packs to the axilla and groin, cool IV fluids, tylenol...  second IV and bloodwork (labs) drawn.

Still seizing, more Ativan...

Still seizing, time to get the ED physician.

The patient was given more Ativan.  The decision made to do a RSI intubation.  NG tube and a temperature probe foley placed.

Seizure stopped, core temperature starting to come down.  A Lumbar Puncture, Propofol drip started, more cool IV fluids, an Arterial line initiated to monitor B/P in realtime...

More labs are drawn, off to CT Scan, and IV antibiotics are started.

Report called, and patient transported from CT directly to the ICU at 11:15pm.

Two hours from arrival in the ED to the ICU... not bad.

But the weird thing is that the patient arrived two hours after the start of my shift, had two hours of Intensive Care provided by me, and two hours after they got to the ICU, I got to "flex down" and leave early!

I had contact/cared for only five patients in my short six hour shift.  My two other patients during this resuscitation, received the benefit of one of the greatest Emergency Teams I have had the privilege of working with!  Not only was I given the support for my "critical" patient, but the two other patients in my assignment at the time were being monitored and taken care of!

At the time I left, we still didn't know if the patient was septic and seized due to their temperature, or was it a heat injury, or was it a fever due to prolonged seizure.  But a temperature from 103+ down to 99-ish, pulse from 160 down to 99, B/P from 180/100 down to 100/70...  let's just say these are very positive trends.

All this on my last shift of a 5-day in a row marathon...

Right place, at the right time.


Peace!

Divine Providence?

So last night, I cared for an elderly patient that was involved in a single vehicle accident.  Seems my patient drove their car off the road into a ditch...  severe damage, airbags deployed.  In addition, the car started on fire and was a total loss.  So already two instances/situations that this patient could have died...  the third was the extreme Phoenix heat, ~109 F yesterday afternoon!

But this patient was able to self extricate, avoid the fire, and was injury free!

But what saved this patient was the fire.  You see, the accident was in a relatively remote location, not well traveled.  This patient could have been sitting out in the desert heat for quite a long time before someone would have happened along to find them... but a big black smoke plume got someone's attention and they called 911 to report the fire.

Ends up, this patient suffered from Alzheimer's Disease, somehow got a hold of the car keys, drove from the East Valley, way out to the West Valley.  Survived the crash.  But in the ~109 F heat, decided they needed to light a candle they had in the car, "in order to stay warm."  The candle tipped, ignited other things, whoosh... the entire car is on fire!

So, it was a debilitating disease that caused a chain of events, that very well might have caused the death of this person in one of three ways.  But it was one of the things this person did, that ultimately saved their life!

For the smoke from the fire caused an emergency response.  No fire, no response.  The patient would have been out in the heat of the desert, stranded for days!  But the fire they caused by the lack of cognitive ability... ultimately saved their life.

Divine Providence!

Pride!

This morning... I went outside to watch the early dawn!  From black sky with stars, to early sunrise... when the stars disappear and the sky begins to turn a blackish blue, into a reddish blue, to whitish blue...  those that have seen it will understand!

While I sat on the porch, I looked across the street and noticed that my neighbor was displaying an American Flag.  Not only was it billowing in the early morning breeze... it was also well lit!  I had seen this Flag several times, but normally during the day.  This morning I realized that my neighbor was following etiquette!  And that made me proud!

For it was displayed overnight... and it was well lit!  The field of blue was somewhat obscured... but the red & white stripes were well displayed!  I walked to the sidewalk and saluted it!

I must be one of those middle generations...  not a Baby Boomer... Gen X or maybe Gen Y...  I do dislike labels!!!

For I knew my maternal grandparents, and they experienced the Great Depression and the World Wars...  I heard the stories, I heard the tales.  I was even honored by my own Grandfather, who told me his own experiences during WWII... something he withheld from his own children, even my mother...  I was the only grandchild to hear it, his story, his history.  And he entrusted me to tell his story, to those that needed to hear it, when it was necessary, when it needed to be told...

A great Honor, but also a great responsibility.

So a lesson learned.

My dad, who is a Baby Boomer started it, but I adopted it and still continue it to this day...

When I identify an individual as a Veteran... I thank them... I literally hold out and offer my hand... and when they take it, I say, "Thank you for your service."

I have been thanked for my service too...

And when that USMC Sergeant came to attention, saluted me, and thanked me for my service... my heart dropped!  Because I didn't deserve it!

I didn't deserve such an honor from someone that risked there life to ensure my freedom... or even someone that represented those that do...

God Bless America!


Peace!

Applying vs. trying...

It's a strange concept for some... but there is a difference between applying yourself and trying to do something.

I tried to explain to someone the difference... the best I could do was hold one hand out to the right emphasizing applying, my other hand to the left emphasizing trying...

I applied psychology, sociology, even adult influence to affect the situation.  But I truly tried to explain the reality of the situation and felt I got a little farther...

I guess that means honesty and reality checks go a bit farther than conceptual ideas, at least in this one limited experience.  I wonder if it can be applied to other situations?  It would need a lot more research, a bit of funding, and a bit of asking questions of previous generations.

All I will promise you... is that I will try to do my best for you!  Regardless of the situation!  And I might even apply some education and experience too!


Peace!

Road trip!

Recently had a few days off... decided to take a road trip on my bike up to Flagstaff!

Part business, part pleasure... got to see a few old friends too!

A good primer for a longer trip.  Went 468 miles RT door to door, including tooling around Flagstaff and a side ride thru Wupatki.

I practiced a few things riding, learned a few things too.

A great place for lunch/dinner is The US 66 Roadhouse Bar & Grill on I-40 in Bellemont!  Definitely a return trip next time I get up there!

Hmmm...

I find myself thinking about how things seem to come around... that is, cycles of life.

It is interesting, to me at least, that situations once dealt with... suddenly reappear... yet at the same time, the situation is just different enough, that the previous solution just doesn't quite fit.

Thinking about edifying my experience.

I need to write a book!

Going for a ride...

I recently bought a motorcycle, OK, almost a month ago!

Had been thinking about it, looking, shopping for awhile... then it became a necessity  Funny how things work out...

Tonight, I did my first "customization" by installing a windscreen.  A quick test-ride afterward, and I thought to myself, "Oh wow!  What a difference!"  Now, purists will say that you need to "feel the wind on your face."  However, those little no-see'ums... those zingers... makes a long ride a little less enjoyable! 

My "break-in" period is almost over... another week and after the initial service, an open road!  Already have a relatively short trip planned!  I got a long trip planned out already too; as well as, I am thinking about a long tour through all of the 48 contiguous United States!  If I add in a Canadian route... might be able to get to 49!  Although, I haven't figured out how to get to Nunavut...

Independence Day...

So now that it is "officially" July 4th... I want to wish all US Citizens a 'Happy Independence Day!'

Strange word really, "independence."  Meaning a state of being independent.  But when one delves into what it means to be independent, as soon as it is achieved, one seems to become dependent once again... so are we truly independent?

A philosophical argument, that would be worthy of not just an essay, but a few thesis' and dissertations too!

Too be independent, I would not be dependent on others... yet I am.
I would not be subject to the control of others... yet I am.
I would not have to require or rely on others... yet I do.
I would not seek out opinions or guidance...  yet I do.

I would be free from the necessity or working for a living.. yet I am not.
I would be free from being bound or committed to a political party...

Yet at the same time, I would show my desire for freedom...

Almost a dichotomy.

For those that have the long weekend, enjoy it! Celebrate it!

For those who have to work, I applaud you!  You are members of the "Silent Heroes!"  I'll be right there with you...


Peace!

Life goes on!

And on and on...

You want to know a secret?  Here it is:  It never ends!

Guess I need to hunker down and just get on with it.

Finally legal!

Finished!  Three total days of training, one classroom, two riding-course days.  Summertime is not the best time to spend 5+ hours a day on the course... especially when the misters in the shade area spring a leak and stop working when it's a 110+ day in Phoenix!

But that pales to the 2.5 hours it took me to navigate my way through the MVD to actually get the endorsement added to my license.  A form to fill out, another form to turn in, surrender the old license, get a new one.  Should privatize the DMV!  No need to deal with three different stations.  Three, actually four, different people because one started a process and then left for lunch...

Sorta humorous to ride up to the MVD, go inside to get the endorsement, to be able to legally ride off...

Then off to the Dealership to actually pick up the permanent license plates.  It's a way for them to get you back into the Dealership.  Finally home!  Showered and ready for a nap!  Switching back over to nights... gotta go to work tomorrow!

I'm exhausted!

Today, I spent 5+ hours riding a bike... day two of three, of a 3 day "riding" course.  Add, that it got up to 100+ degrees, limited intermittent shade, extreme situations, fatigue, minor dehydration... 

I was humbled. I learned some things, identified, owned, and started to correct bad habits...  This was a good decision.  I will be a better rider and driver!


One more day.  Then better prepared than the AZ DMV requires!

Training is a funny thing.  Anyone who has Military experience will understand, although I have none.  Just quasi-military... firefighter, paramedic, nursing.  From no or limited experience... to the max!  Better prepared for the middle...

No Lunch...

It's been a really long time since I didn't take a break during my shift.  Working nights the cafeteria is open for two hours, from 1am till 3am...  so for me last night, nothing but snacks, and although I might get disciplined, a patient meal box!

But I'm an Emergency Nurse, and last night, my needs were eclipsed by another's...

I am amazed and impressed that there is no judgement regarding history and situation when a true emergency situation exists... don't get me wrong, when the crisis is over and the results are back, then the "oh... that explains it!" happens...

My fellow nurses, lab techs, respiratory techs, rad techs, ED techs, and others stepped up, and not only helped me with this patient... but made sure my others were watched, cared for, and taken care of.  Teamwork at it's finest!

But the purpose of this little story, is a glimpse at my motivation.

I do what I do.  For some reason, I have always found myself being adept at handling crises, emergencies, and difficult situations.  And first and foremost... my priority is to avoid and prevent situations from unraveling into a true emergency!  Truly, an ounce of prevention is worth a pound of cure!

The other night I received one of the biggest compliments I have heard.  One of the Rad Techs coming to take a portable CXR said to me, almost in passing, "I like working with you... you're always so calm."

That sums it up right there!  I want to be part of the solution, not part of the problem... I remain calm, people around me see that I am calm, they remain calm. When I do get anxious and ask/call for help, I get a quick response... because I am the one usually responding to others...

There's more I could say, but I think that's enough.

Peace!

Scary situation!

There is a new class graduating...

It's amazing that I know nothing... yet for the next 6 months, I will be asked my opinion!  I seem to know everything about the patient...  and my every whim is an "order"...

And when I question you, ask you to clarify, make sure you are really sure...  and when I ask you again... that is a big, obvious hint!

The last thing I need is an attitude!

My job is to not kill anybody!

You are welcome!  By the way!

PGY-I Good Luck!

Nightshift

I must profess, defend, support, and declare... That those that work the nightshift are a "special" breed!

I have worked the vast majority of my life either doing 24-hr, multiple days, or night shifts.  And regardless, when the call comes in or the patient arrives, the game is on!

I'm two down, one to go... and I can't remember working so hard or being so busy these past two days, in a very long time!


Kudos to my co-workers!  We did it and got through it!

Same to the nightshifters everywhere!  We are truly a special group!

Midnight Sun!

No, I wasn't that far North... but almost!  Give it another month and maybe...

Although the "daylight savings time" did throw me off a bit!  My body said 9:30pm!!!  Time was 10:30pm...

But it was a bit interesting none the less.  Sunrise was around 5:30-ish... got "light" with dawn a bit earlier.  Yet sunset was 10:30-ish... with dusk lasting till almost 11:30-ish!  Between the time change, and the long daylight, it really messes with your internal clock!  I gazed upon a big orange blob around 10pm just above the horizon... it was truly a sight to see!  Actually quite beautiful! 

People out cutting their grass at 9:30pm... going for a bike ride late, watching the sunset... it was surreal!
I never looked up at night.  I regret that.  I was far enough North that I could have seen the Aurora Borealis, if it was on...

I really enjoyed my visit!  I miss my friend!

O Canada!

Now, I am not a world traveler.  In fact I have a very limited experience, only having been to three other countries besides the US.  So by no means am I an expert, nor will I consider myself "well traveled" until I have at least a few more stamps in my passport...

However, I just got back from spending a week in Grande Prairie, AB... for those not willing to Google, that's Alberta, Canada!

My time there was spent with a very dear, close friend!  We drove around town, went to the museums, walked through parks, went for rides, visited her friends & family, cooked, did yard work, shopped, went swimming... I only scratch the surface...

Not withstanding the metric system, which I now wholeheartedly believe one must be immersed in it to fully understand it; I experienced, felt, learned, and observed quite a bit in my week there!  Perhaps I will share some of it in the months to come.

But for now, next time you get a Canadian coin... like a penny, nickle, dime, or quarter... don't fret it!  In Canada, there is no discrimination between Canadian and US coinage of the lesser denominations... however; you better stick with the Loonies and Toonies!  And if traveling there, when you arrive at an International Airport, most often you can pay with US Dollars and ask for change in Canadian Dollars... just a tip/hint...

Peace!

Vacation!

Going away for a week!  Cooler temps for sure!  No beach unless a lake shore counts!

Peace!

Imagine for a moment...

That you love someone so much that you would risk you're own life for...  That you would not even think about yourself, and jump straight into a situation...  That you would disregard your own limitations... No time to think, no time to consider the situation, just a pure reaction...

That happened last night. For a mother who could not swim... whose child was splashing in a pool.

Imagine now... the intelligence of a child that knew his mother was in trouble and knew there was absolutely no way that they could help their mother, except to go seek another adult's help, running out of backyard/pool area to a neighbors house, being able to explain the situation in such a manner that the adult understood...

That happened last night.  For a child whose mother just got them out of the pool.

Now imagine... the foresight of an adult, running and responding to emergency, to call 911 as they made their way to there... who got there, pulled their neighbor out of the pool, and immediately began CPR...

That happened last night.

The rapid response of the EMS/Fire crews... the quick interventions... the decision to rapidly transport via helicopter to the closest facility better equipped to handle this emergency.  To the ED Doctor, RNs, the Lab Tech, the Respiratory Tech, the Rad Techs, the ED Pharmacist, the ED Tech, and the HUC...

That happened last night.

I was the primary ED Nurse. 

That's what happened last night. 

Ever have one of those moments?

One of those moments you realized you made a mistake... one there was no good recovery from?

The choices, actions, words... they were now made, done, said/not said...

Especially, when you've made very similar mistakes in the past... yes, you learned, but circumstances were just enough varied that your conscious mind didn't register it...

I fear I lost something very special to me...  and all because of something I did, or did not do...

You know, I have been hearing God whispering to me... this time he went straight to the 2x4!

Alternative Energy

I am all for forms of alternative energy (that is not from hydrocarbon sources)!

Recently, a local school district erected a massive steel structure... covered it in solar panels... and called it a "green project!"

I wonder though...  How much electricity was used to smelt said steel, the fuel burned to truck in the pieces, the fuel burned by said workers to get to the construction site, the hydraulic lifts used to raise the workers (I bet they ran on diesel fuel...), the arc welders, etc...  how "green" was this project?  And this massive solar array will power what?  One building?

This is my opinion: Unless you are stringing a cord outside, and using the sun and wind to dry your clothes... don't talk to me about "green" energy!

I once harvested rain water, even ran it to my toilet, that emptied into a septic system.  Flushes were minimized,because of the rain barrel volume... and the small pump that ran on batteries charged by a solar cell, that only had so much juice!  Showers were kept short because it was well water.  I even started building a wind generator (aka windmill).

So if I buy an electric vehicle... I ask, where will the electricity come from?   Coal? Oil? LPG? NG?  Nuclear? Oh... maybe from those windfarms I see when going to California... maybe from that Solar plant they just built...

The World needs a bridge... get from oil dependency to something else.  Don't force the transition... it will happen.

A throwback to simplier times...

I know I am going against the grain here... after all, it's all about progress and advancement... right?

But as I think back over history, and even watch what some would consider "classic" movies/TV... as hard as it was, I find myself wondering if it was actually easier...

So...

One had to get up at the crack of dawn... meant you went to bed early, probably even by sunset!
There were at least three meals a day, sometimes four... meant your belly always had something!
Had all the food you needed, between livestock & crops... meant you had to work 6 days a week though!
Had one day off a week... meant you worshiped your God though!
You knew your neighbors... meant you relied upon them and they you!
Generations lived together... meant you needed to love one another!
People were self-sufficient... meant they were able to help others within their means!
Almost every family owned a gun... meant everyone else knew that too!
Horse thieves were despised... meant you were hanged if caught!
Most people had manners... meant a civilized society!
Almost every boy could whittle... meant they had a valuable tool!
Hats and handkerchiefs were the most important accessories... meant you had two valuable survival items!

I could go on... but I digress!

Things seemed hard... meant you were hardened!

I can do without my cellphone, my TV, my internet... heck, I know where the Post Office is! Might take me 30 minutes to walk there though...

A Day! A week!

It is National Nurses Day!  The start of a week long celebration culminating with the celebration of a life!

How appropriate!

Tomatos and Peppers...

My Beefsteak tomato plant is doing so-so... a few blooms, maybe some fruit... there are a number of tomato plants on porches in my neighborhood... at least it is growing so I have added the aluminum cone/lattice!  There are a few leaves that have been munched on, but no resident pest...

The Jalapeno plant is growing and thriving... keeping up with the tomato!  No flowers yet...

Will keep you posted!

Green Thing II

I can remember when plastic grocery bags first came to be!  You see, I was a "bag boy" at a local supermarket...

Supposedly, this was better for the environment, as we weren't cutting down trees to make the paper bags anymore!  Oh how times and arguments have changed!

We went from, "Do you need a double bag, ma'am?" to "Paper or plastic, please?" to "Did you bring your own bags!?"  You know, I actually recall people bringing those brown paper bags back into the store to be reused... and when we went to plastic, they still brought them in and had us bag into them first, then set into the plastic...

There was a time that the only thing put into plastic bags was your ice cream and other frozen foods... just so as it melted on the way home and the condensation formed, it wouldn't affect the integrity of the paper bag and cause it to rip/fail/disintegrate as you carried it in to your house...

So as the plastic bags fill our landfills... I think back and wonder...

Who pushed for those damn plastic bags over the paper ones anyways!?  And as our forests are overgrown, causing fire hazards now, the whole fire suppression mismanagement issue is another blog...

I guess the whole recycle thing failed.  I can send a paper bag to the landfill, and it is degraded, absorbed, gone, reduced to its essential parts in a few years.  Heck, as an organic source of nutrients, it might even feed a tree someday...  I send a plastic bag there... it's there for supposedly hundreds or even thousands of years?! Try leaving one of those plastic bags out in the sun for a few months... turns to dust!

And those "green" bags... most made outside of America... check the lead levels in them!  More toxic to the environment than even the CFL's with all the mercury, which are also mostly made outside of America too!

I guess as hard as we humans try to screw up this world...

As hard as we try to influence things, change things, and make things better...

We are up against a bigger power and force!

Maybe we should just leave things alone, as they are, and just do what we do.  Let the balance return.

That's a concept that won't be accepted anytime soon...


Peace!

The Green Thing

 I got this in an email today, not one to cut and paste, I make the exception!


Subject: The Green Thing

In the line at the store, the cashier told the older woman that she should bring her own grocery bag because plastic bags weren't good for the environment.

The woman apologized to him and explained, "We didn't have the green thing back in my day."

The clerk responded, "That's our problem today. The former generation did not care enough to save our environment."

He was right, that generation didn't have the green thing in its day. Back then, they returned their milk bottles, soda bottles and beer bottles to the store. The store sent them back to the plant to be washed and sterilized and refilled, so it could use the same bottles over and over. So they really were recycled.

But they didn't have the green thing back in that customer's day.

In her day, they walked up stairs, because they didn't have an escalator in every store and office building. They walked to the grocery store and didn't climb into a 300-horsepower machine every time they had to go two blocks.

But she was right. They didn't have the green thing in her day.

Back then, they washed the baby's diapers because they didn't have the throw-away kind. They dried clothes on a line, not in an energy gobbling machine burning up 220 volts - wind and solar power really did dry the clothes. Kids got hand-me-down clothes from their brothers or sisters, not always brand-new clothing.

But that old lady is right, they didn't have the green thing back in her day.

Back then, they had one TV, or radio, in the house - not a TV in every room. And the TV had a small screen the size of a handkerchief, not a screen the size of the state of Montana. In the kitchen, they blended and stirred by hand because they didn't have electric machines to do everything for you. When they packaged a fragile item to send in the mail, they used a wadded up old newspaper to cushion it, not styrofoam or plastic bubble wrap.

Back then, they didn't fire up an engine and burn gasoline just to cut the lawn. They used a push mower that ran on human power. They exercised by working so they didn't need to go to a health club to run on treadmills that operate on electricity.

But she's right, they didn't have the green thing back then.

They drank from a fountain when they were thirsty instead of using a cup or a plastic bottle every time they had a drink of water. They refilled their writing pens with ink instead of buying a new pen, and they replaced the razor blades in a razor instead of throwing away the whole razor just because the blade got dull.

But they didn't have the green thing back then.

Back then, people took the streetcar or a bus and kids rode their bikes to school or walked instead of turning their moms into a 24-hour taxi service. They had one electrical outlet in a room, not an entire bank of sockets to power a dozen appliances. And they didn't need a computerized gadget to receive a signal beamed from satellites 2,000 miles out in space in order to find the nearest pizza joint.

But isn't it sad the current generation laments how wasteful the old folks were just because they didn't have the green thing back then?

WOW!!!!!!!!!!!

Psychosis

Last night, I walked over to another area of our ED where we hold patient's that have been admitted and are waiting for inpatient bed assignments or are waiting for transfers to other facilities, to give report on a patient that I was about to move into this unit.

There was a patient that was already there, awaiting a transfer to another facility... who literally, just as I got there, right as I walked in, had a violent, psychotic break. The patient body slammed a Security Officer, was yelling at and threatening everyone, swinging at (and hitting) and kicking at (and connecting) at a Nurse and Nursing Assistant.

I watched as the patient swung at the Nurse, the Nurse blocked and grabbed the patient's arm in an attempt to control the patient, and the patient proceeded to lunge at and bite the Nurse's wrist, breaking skin. Not withstanding the Employee Exposure that just occurred, this patient had now committed a felony with the assault & battery against a healthcare worker... but that is a different story.

This all occurred in less than 10 seconds... but it seemed to take on that weird, slow-motion, as it was happening time slows down kind of thing...

The Security Officer recovered and had regained physical control of the patient's upper extremities, but now the patient was wildly kicking at anyone in the immediate vicinity. The Nurse and Nursing Assistant had taken a step back. I set down the paperwork I had in my hand and walked over and into this situation.

I'm not the gung-ho, ninja, get into the fray, kind of Nurse... nor was this a male thing, watching my female co-workers getting hurt... this was a crisis for everyone involved; both the patient and my co-workers! This situation needed to end quickly to prevent escalation and further injury to all, the patient and my co-workers.

Too make a long story short, I side stepped towards the patient, the kick came at me, I blocked and grabbed the ankle, held the leg up, crossed the knee over the patient's other leg, looked at the Security Officer, said "floor now!" The Security Officer started to go down, I went down, and suddenly this patient was one the floor, injury free, under physical control, and was able to receive an emergent injection of an anti-psychotic medication intramuscularly. Within 5 minutes we were able to safely transfer this patient back into their bed.

These things don't happen that often. And rarely, as dramatic as this situation played out.

I won't get into the felony thing, as a patient's offense has to be truly egregious for a healthcare worker to even consider pressing charges...

Yet here again, I found myself somehow being right where I needed to be, right when I needed to be there.

The point of my ramblings? I don't know, maybe just to share and decompress? Maybe to educate that when I don't get to your request immediately, I might have been busy with something more pressing? Maybe it's just to give you a glimpse into what I do? Who knows... take from it what you will...

I took some Ibuprofen about an hour later, as I felt a little twinge in my back... about to take some more before sleep time!


Peace!

Christos Anesti!

I guess that's the beauty of a foreign language! You gotta figure it out and translate it!


Alithos Anesti!

I want to be an Air Traffic Controller!

Then I could work a really long shift, and as the ATC Union is advocating, be able to take a nap too!

Oh... and I would make $160K a year!

What union in there right mind would advocate any employee working more than 8 hours a day, for no more than 5 days a week? OK, maybe 12 hours a day for 3 days a week, or 10 hours for 4...

I get that it is a stressful job. After all, the ATC's are responsible for thousands of lives every minute! Wouldn't that make you want to advocate for shorter shifts first?

I work three 12-hour shifts... and that is stressful. I can't crash an airplane, but my inattentiveness can crash a patient! So hundreds of lives are more important than one...

Maybe I should ask my employer for a nap period... Guess I should start looking to flip burgers!

Spending vs. Revenue

Why is this debate being framed around the "revenue" side? Tax more, tax the rich, bring more revenue in...

Has this entity we call the Federal Government taken on a life of it's own?

How about framing it on the "spending" side? Spend less, cut budgets, reduce the size of government...

Wouldn't need to raise taxes then! As the government wouldn't need more revenue...

Hmm... could my taxes go down?

I am all for supporting and helping those truly in need. But is that the Federal Government's job or is it the local community's job? As Hillary Clinton reiterated, "It takes a village to raise a child." Note, she didn't say "nation!"

I had someone ask me for money the other day because they were out of gas. I offered to pay for there gas and asked where there car was... of course, it was "down the road." I'll fill your tank if you truly need it... but I am admittedly cynical when you want my cash instead!

So how is that different when the government takes my money in the form of taxes? They are better at spending my money where it is needed than I am?

As the most generous Nation on this Earth, I think people should be left to spend, and more importantly give, there earned money where they feel it is best used.

And if you are on welfare...

I have always said, I will get a minimum wage job flipping burgers before I become unemployed!

After all... a minimum wage is a government guarantee that you are above the poverty level!

Medicare

So...

If I have seen them, I know everyone else has too, so I will ask the question!

If Medicare is the end all, perfect, don't mess with it, insurance, why then are there so many companies offering those "supplementals?"

Obviously there are only three conclusions.

1) There are quite a number of companies that are scamming those on Medicare, offering them "gap" coverage, in an effort to get rich.

2) Medicare is not all that it purports to be. Necessitating people on Medicare to seek help outside of the government.

3) ...

There is always a different answer. I wonder what the thoughts and answers are...

So?

Tomatos, peppers, and taxes!

They have survived... they are growing... Updates and photos later!

But more importantly... I am a bit mad!

You see...

I get a refund this year, both from the Fed and the State! Now most people would be happy, but I beg to differ!

If I had underpaid my taxes, owed a certain amount, I would be penalized! That is, I would get an "Underpayment Penalty" and could potentially have to pay interest on the amount I owe, that I did not pay...

Now here I am. I overpaid my taxes, am I rewarded?! That is, am I eligible for an "Overpayment Award" and will I be paid interest on the amount I loaned to the government, that they didn't immediately refund/refuse to accept...

And if you think the current tax system is unfair...

I beg you, I plead, I just ask... read the current Tax Code... Read through the current tax laws, page by page... Please explain it to me! I don't expect an answer for at least 3 years, but by then, it will have changed again...

Hmm....

Beefsteaks and Jalapenos!

I thought about commenting about the current news cycle. But I figure anyone can go back and read my views on that, so why write anymore about it.

So, I heard my niece today having a temper-tantrum. Seems she was upset that her parents didn't take her with, when they went to the store. She was left in the care of her 18 year old sister, and the defacto resident uncle. Now being the kind, compassionate, nurturing uncle that I am, I went downstairs and just asked what all the fuss was about? Seems just by me asking, the tantrum stopped. I fulfilled my uncle duties today.

After this, I went out to a local establishment that has a garden section. Bought a pot, some soil, and two plants: a tomato and a pepper. When I got back, I walked in and my niece looked at me. I told her she better put on her shoes. I can not adequately describe in words the look on her face... even if I had a camera, the 2-dimensional image would pale...

For the next 30 minutes we decided where the pot would go, moved other pots around, filled the new pot with soil, decided where the plants should be in the pot, and then got our hands dirty digging.

So if they grow, survive, produce... I might get around to posting a picture or two...

Race, creed, color...

"...without discrimination, based on race, creed, color, sex, age, national origin, handicap, or veteran status..."

"An equal opportunity employer to all regardless of race, color, creed, national origin, ancestry, sex, marital status, disability, religious or political affiliation, age or sexual orientation."

See the subtle change? And this one is my favorite!

"...is an Equal Employment Opportunity employer and will not discriminate on the basis of sex, race, creed, color, national origin, ancestry, age, disability, veteran, marital or citizen status or sexual orientation or any other status or category protected by law..."

Guess they got tired of changing the disclaimer...

I promised to not step onto this soapbox again, so I won't... sorry I kicked at it...

And regardless of what your answer was... it is yours!

That's what I think is most important...

Each of us are quick to comment, quick to judge, quick to post links to opposing viewpoints...

I admit, I didn't commit to a full retreat... I even left the door open. But in my defense, there are pics that other people might still want access to, and they are in my albums, on my profile. Although I think that by me posting them, and I verified that I have the exclusive rights to them, they are somehow there forever, I must have agreed to sign my rights away in that 3 page, 2000+ word agreement I didn't read and just clicked on the "I Agree" button... after all, I can't delete any of them now!

Do you really want to know what I am doing? Do you want to know where I am? Do you want to know what I am thinking right now? I hardly know myself moment to moment! So how can I update everyone?

And how can I change your viewpoint? I obviously failed at that more than once! People are so entrenched in the here and now, and when it becomes passe they move on to the next thing. I am guilty of that myself... heck, I enabled text messaging and finally got a text message friendly phone 2 years ago... and recently I was thinking/talking about getting a "smart" phone... I know... way late!

So here's my update... I might update it later, after all, I'm obviously blogging this, so I haven't completely rejected technology...

I want a house, with a porch. And on the porch is a swing. And there is a handmade afghan that I can grab to keep me warm if needed. And the porch is situated so that if there is a river, or a stream, or a lake nearby, it faces it it!

And I want to walk out to my mailbox. There will be a barrel right next to it too... might get lit every now and then!

And there is a garden, that I grow all of those veggies that my former neighbors thought I was crazy to do in my front yard, but were first in line to ask if they could have some!

And I will wait.

Because one day, my true love will open the gate and walk up onto the porch, sit down on that swing, pull the afghan over, look out to the water...

and say "I missed you!"

A question.

What is the most important thing you have done in your life?

No quick answers... you need to think about this for a minute!

It has become glaringly apparent to me that I have failed once again.

It is time that I listen to my own advice and realize that the only common denominator in all of this... is me.

I am sure that is fodder for some!

Thank's for listening!

Be back later!

Wow!

The other day, I was at local gas station/convenience store...

As I stood there waiting for my tank to fill, I noticed this big, non-descript truck.

As I scanned my surroundings, I noticed these two guys moving a pallet that was filled with bags of ice. Two guys, one pulling the pallet jack, the other pushing the pallet... obviously it was heavy. Heck, probably was a ton of ice! 200 bags, 10 pounds each!

But these two guys got within 10 feet of the outside freezer and stopped. They then both walked back to the non-descript truck and got a cart, wheeled it over to the pallet, and began transferring the ice from the pallet onto the cart.

I don't know why, but I was so intrigued that after my tank was full, I pulled my truck up to a parking space near where these guys were working.

I sat there and watched them throw bags of ice from the pallet to the cart. Then, when the cart was full, they wheeled it over a mere 10 feet to the outside freezer and began to offload the ice into the freezer. One of the bags fell off, and broke open... they just kicked it out into the parking lot to apparently melt down.

I'm thinking to myself, I want this job!

This is the scary thing...

I am a inclined to open a business, one that picks up garbage, recyclables, etc...

I don't care really if you separate it all out. Heck, you don't even need to rinse out the cans of tomato sauce! Just throw it all out there, into that one bin!

I would only charge you $10.00 a month to come pick up your trash... the things you are throwing away... heck, I would even come around once a month and haul off the big things that won't fit into the bin!

I would hire employees to drive the trucks, drive the front loaders, sort through it all... and the impact of me building the processing plant! Oh my! The temporary construction jobs, the engineers, the architects, the scientists...

Oh wait! Here's a better idea! Snow Removal! Imagine if there was someone that would come in and front-load all of the snow in your town...

Pile it into trucks, haul it away! I could move snow from the NE to the SW! It would melt, but it would affect the drought in certain areas! Imagine all of the water redistributed! Major melting plants, gigantic concrete holding tanks, of course there would need to be treatment plants as well...

I need to consider these ideas...

Oh well, it is just some thoughts...

Just Stop!

Just stop!

Want to fix the US Deficit/Debt? Here's a solution...

STOP SPENDING MONEY YOU DON'T HAVE!!!

Either stop spending or raise my income taxes! But be prepared...

Raise my taxes too high, and it will eventually become not profitable for me to work and contribute to my society! Then I will stop working, have no taxable income; therefore no longer contributing, and will be potentially drawing upon government benefits! I don't pay into the system, but I can collect from it!!!

Then you will have to increase taxes on those that are willing to try... even more! How much? 45, 55, 75... 100%

See the problem?

For all of my friends that want it for free, or to give it out for free... give it! Give it all!

If you truly consider yourself a Democrat, a Liberal, a Progressive... why do you enjoy anything? Shouldn't you give it all up? Sell your house, give everything you earn, have absolutely no "net" income?

See the problem now?

Heck! Michael Moore can help reduce the deficit! Sell off his shares of Halliburton (owns 2,000+ shares) Capital Gains alone might actually impact the deficit! Oh... did I mention he is one of the "ultra-wealthy?" I wonder how much his income taxes are? After all.. he makes more than $200K a year... Oh wait... he has loopholes...

Still don't see it?

Well, then I wont comment anymore...

"I love you to death! But, my ultimate goal is to get rid of you!"

Ah... the smiles, the laughs, and the "Whats!?!?"

You see, that is my "tag-line."

Many people that might have heard that from an ED Nurse or others... well, I am proud to say I helped pass it on to many others! I don't remember where or when I first heard it, but it struck and stuck with me as the perfect metaphor for what I do!

Again, I am not the first to say it, and I don't know how many have picked it up, and I am sure many, many more have said it also! So... if you find yourself in the situation that you had to go to the ED, and you happen to hear or even overhear a Nurse say that... speak up! And say, "Excuse me! I know a nurse in Phoenix, Arizona that frequently says that!" Now, you will have to quickly explain that you heard or read from me, or know someone who knows me who reported I said that... or else a certain cynicism might be reared... but eventually in 50 to 100 years... through FB, MSp, email, and whatever is to come, I just might be referenced!!! ;)

You see, I will advocate for you, do everything that I can for you, and make sure you get what you need, if you are a patient of mine in the ED. You and I will not always agree on the priority status of said need... but due to HIPPA regulations, I can only tell you that you are one of X number of patients that I am caring for, or you are currently are one of X number of patients in the ED at the time...

As I said, it is the perfect metaphor!

You see as an ED Nurse, I want to help you and get you through the acute interventions/treatment/diagnostics/disposition process as quickly as I can. I will admit, this is both a professional and personal goal...

Most people don't want to spend hours in the ED. Likewise, I as a Nurse don't want you here either! There are a bunch of really sick/ill people that come to the ED... sometimes they have problems that I want to minimize my other patients exposure to! So it is a two-fold process... get them through, and get you through! Part of me "rushing you through the process" is that you are OK and will be fine! Who really wants to be in a place that they really could be exposed in/to and get sick from just being there? This really boggles some of my younger parents, who bring their baby in for a fever... tests are done, and we quickly discharge them often. They seem upset, but when I explain that your baby has a cold, a viral illness, etc... you really don't want to be here with all of these contagious diseases around... they are quick to want to leave. Don't get me wrong, we do the tests, the diagnostics, we confirm quickly... a kid with a cold next to a kid with CAP (community acquired pneumonia) or RSV... needs to get out of the ED and home ASAP!

I really don't make an effort to make anyone wait for things, especially a discharge to home! Your good... OK... nothing life-threatening, I want you to be able to get home as quickly as I you can before you are exposed to some contagious disease or other process/problem that might make you sick! But if you are sick/ill and require admission, I want to get you to where you will best be cared for and taken care of as quickly as possible.

So last night I had all three, well maybe 2.5 ...

I got a smile, and a thank you as I wheeled my patient to their inpatient room...

A laugh, this is the 0.5, as it was really a chuckle and a question as to why I wasn't going to be their nurse overnight... this patient had been somewhat heavily medicated for their condition/problem!

And a "What!" Your discharging me!?" Apparently this patient did not receive the treatment that they expected... nor the diagnosis... nor the expected prescriptions! ;) Even though... ___

Well, fill in the blank... even a non-nurse, non-ED HCW can probably fill it in!

Remember!

I love you to death! But my ultimate goal is to get rid of you! My job is to get you were you need to go/be!

Professionalism vs. Realism

A few years ago (1998) the IOM released a report/White Paper on patient safety, titled "To Err is Human." Detailing how bad the health care system was in America... how up to 98,000 preventable patient deaths a year, were associated with poor processes, medical errors, etc.

How far have we come?

There have been billions, if not even trillions of dollars spent on the creation of new Organizations, Governmental and Quasi-Governmental Agencies, mandatory reporting databases, Consultants to help health care providers comply; the list goes on and on!

I am still looking for a good, critical research paper that outlines and details the changes and progress that has been made. What the "best demonstrated practice" is. What works and doesn't work.

What I would like the most, is for the original researchers, or new researchers using the same method, sample size, data stream, etc., to repeat the study! Let's compare oranges to oranges, as best we can! Although I fear it will be oranges to tangerines at best, maybe citrus to citrus...

Please don't get me wrong! There have been substantial improvements! Massive changes! Heck, I hardly recognize the profession I am in from when I started 15 years ago. There are so many variables involved in providing health care services; the training and education, the technology, the care models, the collaborative team models, the drugs, the interventions, staff mix, patient acuity, patient demographics, insurance reimbursements, medical malpractice... all of it has changed! I don't think the original study could even be correctly, that is scientifically, reproduced!

What worries me the most is that health care services, are de-evolving into a consumer-driven industry... Door to Doctor time, Average Wait time, Patient Flow, Patient Throughput time... about the only thing I can agree with is the Insult to Intervention time! At least that has some science behind it! The old mantra of "time is muscle" for an acute myocardial infarction (AMI)... that made sense! And it makes sense in quite a few other conditions too!

And believe me! You come to the ED and you have a true emergency or even a potentially true emergency... you don't wait! You are brought straight back, and multiple health care workers are at your bedside and are doing multiple things, almost simultaneously, to determine if it is real, potential, or not happening.

My patient is "dissatisfied" because they had to wait in the ED lobby for 2 hours to see a Doctor for a non-emergent condition? Or they were "rushed back but ended up waiting hours!"? Or perhaps it took me 15 minutes to answer there call/request for something to drink, pain medicine, a warm blanket, or the best... the ultimate question: "how much longer is 'this' going to take?"

How does that reflect on my overall patient care? So I should leave the patient that I am doing critical interventions on, giving IV fluids, blood products and vasopressors to... due to a blood pressure of 60/40, an H&H of 5.6/14, a Platelet count of 2, and a raging sepsis... to get a Percocet for someone who is complaining of back pain that has been chronic for three months and suddenly became an emergency tonight?

And I am not even to the number of patients that get admitted to a hospital for obviously very legitimate reasons, that spend a day or more in the ED, due to lack of available inpatient hospital beds!

I am probably one of the most compassionate and caring people you will ever meet. That's part of what makes me a good nurse!

Another part is that I will strongly, even forcefully, advocate on your behalf if I feel you need something. I have "literally" stood toe to toe, face to face, with other health care team members, to make sure that the patient I was caring for got what they needed, when they needed it! And there were sometimes red faces, loud voices, and elevated blood pressures involved too!

I now must apologize.

I am sorry I went on this diatribe, stepped up on this soapbox. In a way, it might even be considered a tad unprofessional.

I had more than a few taxing moments these past few shifts. I wonder how I can overcome, deal with, find solutions for, and prevent future occurrences?

I just hope and pray I made a difference, an impact, and helped save those three lives just this last night...

One last thing, and this will make some people upset, mad, even outraged...

I am an ED Nurse... I save your ass! I don't have to kiss it.


Peace!

I am "officially" old!!!

I was drawn back to my youth... remembering things... and I realized I am old!

I grew up in an age that didn't have cable or satellite TV; we knew who our garbage man, mail man, milk man (yes... milk was once delivered to your doorstep every morning!), even the Charly's Chip man! There were no cellphones and when we finally got cable... I watched the launch of MTV!

Isn't it a bit sad?

Really?

A nut job does something in the US a frickin week ago... and that is an excuse for people half a world away to kill people!?!?

And yet I read on FB people trying to defend this!?!?

I'm sorry... really? Seriously?

I revert back to some science I learned in HS...

"for every action there is an equal and opposite reaction"

I guess this ultimately reverts to the ultimate question! Which came first? The chicken or the egg?

Wow! It's been over a year since I have been here!

As spring is in full swing and it feels like summer is already here... I remember one winter I pulled out a winter coat because it was snowing one morning in Flagstaff as I went to work. I hadn't worn that particular coat since the previous winter. Imagine my surprise when I reached into the pocket and pulled out a $20.00 bill!

It almost felt like I had won the lottery!

Here I had a hidden, albeit forgotten, mini-savings account! I had an extra $20.00! I bought my lunch that day, rather than making it and bringing it!

I had a similar experience the other day...

I recently posted some status updates on FaceBook, actually more a rant... trying to express and vent some frustrations... and a high school friend commented and mentioned I should have a blog. What happened next was the classic forehead slap, uttering a duh!, and me trying to recover passwords to be able to access this blog and reinstate it!

A hidden, albeit forgotten, account! I have another outlet! So here is where I will post, comment, make observations, do all of the blogger-like things, to hopefully free up some bandwith on FB!

So...

A lot has happened in the past year!

I have now been to Haiti a total of 3 times, I've moved back to PHX and obviously changed employers, I have re-entered/returned to my area of expertise: Emergency Medicine.

Not to overwhelm or scare anyone, but, oh boy! Do I have stories, anecdotes, observations, comments, and things to share/post/blab about! But I will ease into it... I promise not to post here more than once every 24 hours, unless something really pressing or important happens, and then I promise it will be short!

Thanks for visiting! Thanks for reading! (only 23 hours 59 minutes left till I post again! LOL)